Concordance and Acceptability of Self‐ Vs. Clinician‐Collected Anorectal Swabs for HPV Genotyping in Gay, Bisexual and Other Men Who Have Sex With Men in Metropolitan Barcelona

Abstract

Squamous cell carcinoma of the anus (SCCA), caused by high-risk human papillomavirus (HR-HPV) genotypes, is a growing concern among gay, bisexual, and other men who have sex with men and transgender individuals, particularly those living with HIV. Early detection of precursor lesions is crucial, yet current screening methods face barriers in access and acceptability. Anal self-sampling has emerged as a promising patient-centered alternative. This study evaluates the diagnostic accuracy and feasibility of self-collected anal swabs for HPV genotyping compared to clinician-collected swabs among the target population. A cross-sectional, multicenter study was conducted in the metropolitan area of Barcelona, enrolling 151 participants. Participants provided self- and clinician-collected anal samples, obtained sequentially. Extended genotyping was performed to detect 28 individual HPV genotypes. Diagnostic performance was evaluated using clinician-collected samples as the reference standard, and concordance was assessed using McNemar's test and Cohen's kappa statistic. Feasibility was measured via a questionnaire. Participants had a median age of 43 years, and 53.0% were living with HIV. Overall, HPV was detected in 89.9% of self- and 92.6% of clinician-collected samples. Agreement was high 96.0%, with a kappa value of 0.75 (95% CI: 0.55-0.94). No significant differences were found between methods (p = 0.22). Sensitivity was 96.4% (95% CI: 91.8-98.4), and specificity 90.9% (95% CI: 62.3-98.4), with similar accuracy for HR-HPV and HPV16 types. Most participants rated self-sampling acceptable and feasible. Anal self-sampling shows high accuracy and strong feasibility, supporting its use as a viable and user-friendly strategy to enhance HPV screening in key populations at risk for SCCA.